| NPI | 1770716375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 510) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: TX 1144) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2009-08-28 |